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BrainScope TBI is a multi-modal, multi-parameter assessment indicated for use as an adjunct to standard clinical practice to aid in the evaluation of patients who have sustained a closed head injury, and have a Glasgow Coma Scale (GCS) score of 13-15 (including patients with concussion/mild traumatic brain injury (mTBI)).

BrainScope TBI provides a multi-parameter measure (CI)) to aid in the evaluation of concussion in patients between the ages of 13-25 years who present with a GCS score of 15 following a head injury within the past 72 hours (3 days), in conjunction with a standard neurological assessment of concussion. The CI is computed from a multivariate algorithm based on the patient's electroencephalogram (EEG), augmented by neurocognitive measures and selected clinical symptoms.

The BrainScope TBI Structural Injury Classification ("SIC") uses brain electrical activity (EEG) to determine the likelihood of structural brain injury visible on head CT for patients between the ages of 18-85 years (have a GCS score of 13 – 15), have sustained a closed head injury within the past 72 hours (3 days) who are being considered for a head CT. BrainScope TBI should not be used as a substitute for a CT scan. Negative likely corresponds to those with no structural brain injury visible on head CT. Positive likely corresponds to those with a structural brain injury visible on head CT. Equivocal may correspond to structural brain injury visible on head CT or may indicate the need for further observation or evaluation.

BrainScope TBI provides a measure of brain Function Index, (BFI)) for the statistical evaluation of the human electroencephalogram (EEG), aiding in the evaluation of head injury as part of a multi-modal, multi-parameter assessment, in patients 18-85 years of age (have a GCS score of 13 - 15) who have sustained a closed head injury within the past 72 hours (3 days).

The BrainScope TBI device is intended to record, measure, analyze, and display brain electrical activity utilizing the calculation of standard quantitative EEG (QEEG) parameters from frontal locations on a patient's forehead. The BrainScope TBI calculates and displays raw measures for the following standard QEEG measures: Absolute and Relative Power, Asymmetry, Coherence and Fractal Dimension. These raw measures are intended to be used for post hoc analysis of EEG signals for interpretation by a qualified user.

BrainScope TBI also provides clinicians with quantitative measures of cognitive performance in patients 13-85 years of age to aid in the assessment of an individual's level of cognitive function. These measures interact with the CI and can be used stand alone.

BrainScope TBI also stores and displays electronic versions of standardized clinical assessment tools that should be used in accordance with the assessment tools' general instructions. These tools do not interact with any other device measures, and are stand alone.

BrainScope TBI (model: Ahead 500) is a portable, non-invasive, non-radiation emitting, point of care device intended to provide results and measures to support clinical assessments and aid in the diagnosis of concussion / mild traumatic brain injury (mTBI). The BrainScope TBI includes a new multivariate classification algorithm that analyzes a patient's electroencephalogram (EEG), augmented by neurocognitive performance and selected clinical symptoms to compute a multi-modal index called the Concussion Index (CI). BrainScope TBI provides the healthcare provider with a multi-parameter measure to aid in the evaluation of concussion following a head injury within the past 72 hours (3 days). The BrainScope TBI (Ahead 500) retains all the capabilities of the predicate (BrainScope TBI, model: Ahead 400) including the Structural Injury Classification (SIC) and the Brain Function Index (BFI). It also contains configurable, selectable computerized cognitive performance tests and digitized standard clinical assessment tools intended to provide a multi-modal panel of measures to support the clinical assessment of concussion / mTBI.

Here's a breakdown of the acceptance criteria and the study details for the BrainScope TBI (model: Ahead 500) device, based on the provided text:

1. Table of Acceptance Criteria and Reported Device Performance

2. Sample Size Used for the Test Set and Data Provenance

• Sample Size: 580 subjects
  • 229 matched controls
  • 144 healthy volunteers
  • 207 subjects who sustained closed head injury and were removed from play
• Data Provenance: The study was conducted across 10 US clinical sites, including High Schools, Colleges, and Concussion Clinics. The study design appears to be prospective, given it involved testing subjects at different time points and with specific inclusion/exclusion criteria.

3. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications

The document does not explicitly state the number of experts used or their specific qualifications (e.g., "Radiologist with 10 years of experience") for establishing the ground truth.

4. Adjudication Method for the Test Set

The document does not explicitly state the adjudication method used for the test set.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

No, the document does not mention a Multi-Reader Multi-Case (MRMC) comparative effectiveness study to assess how much human readers improve with AI vs. without AI assistance. The study focuses on the standalone performance of the Concussion Index (CI) algorithm.

6. Standalone (Algorithm Only) Performance Study

Yes, a standalone performance study was done for the Concussion Index (CI). The reported sensitivity and specificity values are for the algorithm's performance in classifying concussions.

7. Type of Ground Truth Used

The clinical reference standard (ground truth) incorporated elements from guidelines published in the International Conference on Concussion in Sport (McCrory 2017; 2013) as well as the National Collegiate Athletic Association (NCAA) concussion policy. This suggests a clinical diagnosis/consensus-based ground truth, likely established by clinicians based on established guidelines and possibly direct observations or outcomes related to concussion (e.g., "removed from play"). It's not explicitly stated to be solely pathology or patient outcomes data, but rather a combination of clinical criteria.

8. Sample Size for the Training Set

The document states that the "cutoff (threshold) CI [was] derived from an algorithm development study that was independent of the validation study," but it does not provide the sample size for this algorithm development (training) study.

9. How the Ground Truth for the Training Set Was Established

The document implies that the ground truth for the "algorithm development study" (training set) would have been established using similar clinical criteria as the validation study, i.e., "consistent with similar changes seen in subjects with concussion," incorporating elements from the International Conference on Concussion in Sport guidelines and NCAA concussion policy. However, it does not explicitly detail the process for establishing ground truth for the training set.

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• The Ahead® 200, consisting of two models, i.e., the Ahead® CV-200, is indicated for use as an adjunct to standard clinical practice to aid in the evaluation of patients who are being considered for a head CT, but should not be used as a substitute for a CT scan. This device is to be used for this purpose in patients who sustained a closed head injury within 24 hours, clinically present as a mild traumatic brain injury with a Glasgow Coma Scale score (GCS) of 13-15, and are between the ages of 18-80 years.

· A negative BrainScope® Classification may correspond to brain electrical activity consistent with no structural brain injury visible on head CT in patients presenting as a mild traumatic brain injury, within 24 hours of injury.

· A positive BrainScope® Classification corresponds to brain electrical activity that may be present in both patients with or without a structural brain injury visible on head CT. A positive BrainScope® Classification does not establish the presence of a structural brain injury visible on head CT.

· The Ahead® 200 device is intended to record, measure, and display brain electrical activity utilizing the calculation of standard quantitative EEG (qEEG) parameters from frontal locations on a patient's forehead. The Ahead® 200 calculates and displays raw measures for the following standard qEEG measures: Absolute and Relative Power, Asymmetry, Coherence and Fractal Dimension. These raw measures are intended to be used for post hoc analysis of EEG signals for interpretation by a qualified user.

• The Ahead® M-200 model additionally stores and displays an electronic version of the Military Acute Concussion Evaluation (MACE) cognitive assessment and user-entered responses to the MACE questions. There is no interaction between EEG-related functionality, including and displaying brain electrical activity, and the function of storing and displaying MACE information.

· The Ahead® 200 is intended for use by physicians, or under the direction of a physician, who have been trained in the use of the device.

• The Ahead® 200 is a prescription use device.

BrainScope® Ahead® 200 is a Brain Injury Adjunctive The Interpretive Electroencephalograph Assessment Aid, Class II device. It is a portable, non-sterile, non-invasive, non-radiation emitting, point of care, electroencephalogram (EEG) device and is intended to provide an objective assessment of brain electrical activity associated with traumatic brain injury (TBI). This brain injury adjunctive interpretive EEG assessment aid is for use as an adjunct to standard clinical practice only as an assessment aid for a medical condition for which there exists other valid methods of diagnosis.

The BrainScope® Ahead® 200 is comprised of two hardware components: the Handheld Device and the disposable Electrode Headset with patient application supplies. The main software components of the Ahead 200 are the application software and the BrainScope Algorithm Library (BSAL). The Ahead® 200 has two models: (1) the Ahead® M-200, which is intended for use by the military, and (2) the Ahead® CV-200, which is intended for civilian use. The Ahead® M-200 and the Ahead® CV-200 have the same indications for use and intended uses with the exception that the Ahead® M-200 model additionally stores and displays an electronic version of the Military Acute Concussion Evaluation (MACE) and user-entered responses to the MACE questions. There is no interaction between EEG-related functionality, including analyzing and displaying brain electrical activity, and the function of storing and displaying MACE information. The Ahead® M-200 and the Ahead® CV-200 have identical technological characteristics except that the Ahead® M-200 contains the additional MACE feature, i.e., an electronic version of the paper and pencil based MACE.

This document is a 510(k) premarket notification for the BrainScope Ahead 200 device, asserting its substantial equivalence to a predicate device, the BrainScope Ahead 100. It focuses on device specifications, safety, and performance comparisons rather than detailed clinical acceptance criteria and a definitive study demonstrating them.

Here's an analysis based on the provided text, outlining the limitations due to the nature of the document:

1. A table of acceptance criteria and the reported device performance

The document does not explicitly state "acceptance criteria" in terms of clinical performance metrics (e.g., sensitivity, specificity, AUC) for the Ahead 200 device. Instead, it focuses on verifying that the Ahead 200 functions as intended and is comparable to its predicate device. The performance data presented are primarily engineering and safety tests:

The document asserts the "Algorithm Performance" passed, and that the "Harmony" classification algorithm used is the same as the predicate device, implying its performance is at least equivalent. However, specific performance metrics (sensitivity, specificity) of this algorithm are not provided in this document.

Similarly, electrical hardware specifications are compared, suggesting functional acceptance criteria for components:

The clinical "acceptance criteria" for the device, in terms of diagnostic accuracy, would typically have been established during the clearance of the predicate device (Ahead 100), as this submission for Ahead 200 claims "substantial equivalence" based on using the "Same Harmony algorithm" and "Same fundamental technology." This document does not present a new clinical study to establish these criteria for the Ahead 200 itself.

2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

This information is not provided in the document for the clinical performance of the classification algorithm. The document states that "All tests were conducted on the new model to establish substantial equivalence to the predicate (Ahead® 100, models M-100 and CV-100, DEN 140025)." These are primarily engineering and functionality tests. Any clinical performance data regarding the "Harmony" algorithm would likely be referenced in the predicate device's 510(k) (DEN 140025), which is not part of this input.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

This information is not provided in the document as it focuses on engineering and functional testing for equivalence. For the clinical performance of the classification algorithm, ground truth (e.g., presence/absence of structural brain injury on head CT) would have been established for the studies that supported the predicate device's clearance.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

This information is not provided in the document.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

There is no mention of an MRMC comparative effectiveness study in this document. The device is a "Brain Injury Adjunctive Interpretive Electroencephalograph Assessment Aid," meaning it's intended to aid in evaluation, not directly replace or be compared in an MRMC setting with human readers. It's an algorithm generating a "classification" based on EEG, which is then used by a physician.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

The document mentions "Algorithm Performance" as a test that passed. The "BrainScope® Classification" (positive/negative) output by the device is described as "brain electrical activity consistent with no structural brain injury visible on head CT" or "brain electrical activity that may be present in both patients with or without a structural brain injury visible on head CT." This implies a standalone classification from the algorithm. However, quantitative performance metrics (e.g., sensitivity, specificity, PPV, NPV) of this standalone classification are not explicitly provided in this document. Any such data would likely be found in the original 510(k) for the predicate device, as this device uses the "Same Harmony algorithm."

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

The "Indications for Use" mention "structural brain injury visible on head CT." This strongly implies that the ground truth for assessing the algorithm's performance (implicitly for the predicate device, as the algorithm is the same) was based on head CT scans.

8. The sample size for the training set

The document does not provide the sample size for the training set for the "Harmony" algorithm. This information would typically be part of the development and validation of the algorithm, likely detailed in the predicate device's 510(k) submission.

9. How the ground truth for the training set was established

The document does not provide this information. Given the ground truth type mentioned (structural brain injury visible on head CT), it would logically have involved interpretation of head CT scans.

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The Ahead® 100, consisting of two models, i.e., the Ahead® M-100 and the Ahead® CV-100, is indicated for use as an adjunct to standard clinical practice to aid in the evaluation of patients who are being considered for a head CT, but should not be used as a substitute for a CT scan. This device is to be used for this purpose in patients who sustained a closed head injury within 24 hours, clinically present as a mild traumatic brain injury with a Glasgow Coma Scale score (GCS) of 13-15, and are between the ages of 18-80 years.

A negative BrainScope® Classification may correspond to brain electrical activity consistent with no structural brain injury visible on head CT in patients presenting as a mild traumatic brain injury, within 24 hours of injury.
A positive BrainScope® Classification corresponds to brain electrical activity that may be present in both patients with or without a structural brain injury visible on head CT. A positive BrainScope® Classification does not establish the presence of a structural brain injury visible on head CT.
The Ahead® 100 device is intended to record, measure, analyze, and display brain electrical activity utilizing the calculation of standard quantitative EEG (qEEG) parameters from frontal locations on a patient's forehead. The Ahead® 100 calculates and displays raw measures for the following standard qEEG measures: Absolute and Relative Power, Asymmetry, Coherence and Fractal Dimension. These raw measures are intended to be used for post hoc analysis of EEG signals for interpretation by a qualified user.
The Ahead® M-100 model additionally stores and displays an electronic version of the Military Acute Concussion Evaluation (MACE) cognitive assessment and user-entered responses to the MACE questions. There is no interaction between EEG-related functionality, including analyzing and displaying brain electrical activity, and the function of storing and displaying MACE information.
The Ahead® 100 is intended for use by physicians, or under the direction of a physician, who have been trained in the use of the device.
The Ahead® 100 is a prescription use device.

The Ahead 100 is a portable EEG system consisting of two models: the Ahead M-100 and the Ahead CV-100. As stated in the Indications for Use above, the only functional difference between the M-100 model and the CV-100 model is that the M-100 stores and displays an electronic version of the Military Acute Concussion (MACE) cognitive assessment and user-entered responses to the MACE questions in addition to all other device functionality as discussed below.

The Ahead 100 device is comprised of the following main components:

1. The Ahead 100 Handheld Unit
2. The Electrode Headset
3. The Patient Interface Cable
4. The Compact Flash Card (CF Card)

The Handheld Unit, Patient Interface Cable, and Electrode Headset interface together to facilitate the collection of EEG data from the patient. The Electrode Headset includes 8 wet gel electrodes integrated into a single use, disposable headset that allows for electrode placement over the following frontal locations: Fp1, Fp2, Fpz, AFz, F7, F8, A1, and A2 as defined by the standardized International 10-20 Electrode Placement System. The Patient Interface Cable connects the Electrode Headset to the Handheld Unit and contains a preamplifier that prepares the electrical signals measured by the Electrode Headset for processing by the Handheld Unit.

The Handheld Unit employs a color, touch-screen user interface and utilizes proprietary software to perform real-time analyses of the collected EEG data. Using the Handheld Unit, the user is able to review the raw EEG data, view spectral plots, and view a number of calculated quantitative EEG (qEEG) measures including Absolute and Relative Power, Asymmetry, Coherence and Fractal Dimension.

The software utilized by the Handheld Unit also processes the collected raw EEG to produce the final Ahead 100 classification. This data analysis includes filtering the raw EEG, performing artifact reduction, computation of a variety of qEEG features across specific frequency bands, normalization of these computed features, a quality check to identify potential outliers, integration of these features to determine the appropriate classification, and finally a graphical display of this classification to the user. The algorithm used to integrate the computed features and determine a classification was pre-established in a separate study, prior to validation in the B-AHEAD II study.

The Ahead 100 device provides one of two potential classifications of the patient's recorded EEG data:

1. "May correspond to brain electrical activity consistent with no structural brain injury visible on head CT in patients presenting as a mild traumatic brain injury, within 24 hours of injury." or,
2. "Corresponds to brain electrical activity that may be present in both patients with or without a structural brain injury visible on head CT. A positive result does not establish the presence of a structural brain injury visible on head CT."

Acceptance Criteria and Device Performance for BrainScope AHEAD 100

1. Table of Acceptance Criteria and Reported Device Performance

Note: The clinical study "failed to meet the predefined primary endpoints" for specificity, though sensitivity was met.

2. Sample Size and Data Provenance for the Test Set

• Sample Size (Test Set): 552 subjects were included in the analysis of diagnostic accuracy per the intended use.
• Data Provenance: The study was a prospective, controlled, non-randomized, pivotal study conducted at 11 study sites in the US.

3. Number and Qualifications of Experts for Ground Truth

• Number of Experts: 3 blinded neuroradiologists.
• Qualifications of Experts: Neuroradiologists (specific years of experience not mentioned).

4. Adjudication Method for the Test Set

• The final head CT readings were reviewed by a panel of 3 blinded neuroradiologists, and classification was determined by a majority of the panel. This implies a 3-reader consensus method, likely 2+1 or 3-reader agreement.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

• It is not explicitly stated that a Human-in-the-Loop MRMC comparative effectiveness study was done to measure human reader improvement with AI assistance. The study focuses on the standalone performance of the device against clinical classification (CT findings). The device is intended as an adjunct to standard clinical practice, suggesting it would be used by physicians, but the study design described does not quantify the improvement of human readers using the AI.

6. Standalone (Algorithm Only) Performance

• Yes, a standalone performance study was done. The provided acceptance criteria and performance results (sensitivity, specificity, PPV, NPV) are for the "Ahead 100 classification," which is the algorithm's output. The study design states, "All treating physicians were to be blinded to the output of the Ahead 100 device," indicating the device's output was assessed independently.

7. Type of Ground Truth Used

• The primary ground truth used was structural brain injury on CT scan (CT+), as determined by a panel of 3 blinded neuroradiologists.
• For subjects with GCS=15, the New Orleans Criteria (NOC) was used for truth assessment if a CT was not performed. If a CT was performed for such subjects, the CT results were used.

8. Sample Size for the Training Set

• The document states, "The algorithm used to integrate the computed features and determine a classification was pre-established in a separate study, prior to validation in the B-AHEAD II study." However, the sample size for this "separate study" (training set) is not provided in the given text.

9. How Ground Truth for the Training Set Was Established

• The document implies that an algorithm was developed and established prior to the pivotal B-AHEAD II study. However, how the ground truth for this separate study (training set) was established is not detailed in the provided text. It would likely have involved similar methods to the validation study (e.g., expert-adjudicated CT scans), but this is not explicitly stated.

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The ZOOM-100DC is used to measure and record the electrical activity of a patient's brain. The ZOOM-100DC is intended to monitor the state of the brain by acquisition and display of electroencephalogram (EEG) signals and by the calculation of standard quantitative EEG (qEEG) parameters.

The ZOOM-100DC records, measures and displays Electroencephalographic (EEG) waveforms which are digitized and processed.

The provided text describes a 510(k) premarket notification for BrainScope's ZOOM-100DC, an Electroencephalograph (EEG). The document focuses on demonstrating substantial equivalence to predicate devices, rather than an independent study proving the device meets specific acceptance criteria based on diagnostic accuracy or clinical outcomes. Therefore, much of the requested information regarding study design, sample sizes, expert adjudication, and ground truth establishment is not present in the provided text.

Here's a breakdown of the available information:

1. A table of acceptance criteria and the reported device performance

The document doesn't explicitly state "acceptance criteria" in the sense of predefined performance targets for diagnostic accuracy or clinical utility. Instead, it relies on demonstrating substantial equivalence to predicate devices by comparing technical characteristics and intended use. The "performance" assessment is based on this comparison.

The conclusion states that "Performance data demonstrate that the device performs equivalently to the predicate devices." This equivalence, rather than a specific numerical acceptance criterion, is the basis for substantial equivalence.

2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

The document does not provide information on a test set, sample size, or data provenance from a clinical study for the ZOOM-100DC. The submission relies on a comparison of technical specifications and intended use against existing predicate devices, not on new clinical performance data from a specific study.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

This information is not provided as there is no mention of a clinical study involving a test set that required expert-established ground truth.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

This information is not provided as there is no mention of a clinical study involving a test set that required adjudication.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

This information is not provided. The ZOOM-100DC is an electroencephalograph, not an AI-assisted diagnostic tool that would typically involve a multi-reader, multi-case study for comparative effectiveness with human readers.

6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done

This information is not provided. The device is an EEG recording and display system, not an algorithm that operates standalone for diagnostic purposes.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

This information is not provided as there is no mention of a clinical study that required establishing 'ground truth' for diagnostic outputs. The device measures and records EEG signals and calculates qEEG parameters; its "performance" is assessed by its ability to perform these functions reliably and comparably to predicate devices.

8. The sample size for the training set

This information is not provided. As the submission is for an EEG device and not a machine learning algorithm requiring a "training set," this concept is not applicable in the context of this document.

9. How the ground truth for the training set was established

This information is not provided. See point 8.

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